Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort.

Summary

The PAMO criteria standardize biochemical and clinical outcome definitions for medical therapy in primary aldosteronism. In 1,258 patients, 52.9% achieved complete biochemical response and 18.3% complete clinical response; higher spironolactone dose, female sex, fewer antihypertensives, and absence of microalbuminuria/LVH were associated with better outcomes.

Key Findings

• Established PAMO consensus criteria defining complete, partial, and absent biochemical and clinical responses to medical therapy.
• Among 1,258 patients, 52.9% achieved complete biochemical response and 18.3% achieved complete clinical response at 6–12 months.
• Higher spironolactone dose (median 40 mg vs 25 mg) and factors such as female sex, fewer baseline antihypertensives, and absence of microalbuminuria/LVH predicted better clinical response.

Clinical Implications

Use PAMO criteria to titrate mineralocorticoid receptor antagonist therapy, monitor biochemical/clinical endpoints at 6–12 months, and identify patients needing intensified care.

Limitations

• Observational cohort without randomization; potential confounding in treatment intensity and patient selection
• Short to intermediate follow-up (6–12 months) with limited data on long-term outcomes

Future Directions

Prospectively validate PAMO in diverse settings; test algorithmic dose-titration strategies; evaluate long-term cardiovascular/renal outcomes and patient-reported measures.